Sexual orientation, identity and inclusive care — formative SAQs

SAQ 1 — The affirming history and the three components of orientation (10 marks)

A 15-year-old attends with her mother for a "general check-up." Once you speak with her alone, she discloses she has a girlfriend, has been bullied at school for months, and has had fleeting thoughts of ending her life. [2] [6]

Questions

1. Outline how you would take a sexual orientation history using the three components of orientation, and justify why they must be asked separately. (5 marks) [2] [4]

2. Describe your immediate assessment and management, including confidentiality, suicide-risk assessment and safety planning. (5 marks) [6] [3]

Model answer

Three components, asked separately (5). Sexual orientation has three components — attraction, behaviour and identity — that frequently do not align, so a single question produces wrong care. Ask attraction ("are you attracted to guys, girls, both, or neither?"), identity ("what word, if any, do you use for yourself?"), and behaviour ("have you been sexually active, and with partners of what gender?") as separate questions. Identity drives rapport and respect; behaviour and anatomy drive pregnancy and STI screening; attraction captures young people not yet sexually active. A bisexual-identifying young woman with male partners still needs contraception and an affirming environment; a heterosexual-identifying young man with male partners still needs behaviour-based screening. [2] [4]

Assessment and management (5). Establish confidentiality and its limits before the history, and hold it: do not involuntarily disclose her orientation to her mother. Take a structured suicide-risk assessment — ideation, intent, plan, means access, protective factors, past attempts — rather than a passing question; any positive screen is a medical emergency requiring a safety plan, means restriction, and crisis or mental-health referral. Screen mood with the PHQ-A, ask about safety (bullying, home), and ask about protective factors (an accepting adult, belonging). Connect her to affirming supports, arrange follow-up, and begin family-acceptance work only with her consent and when safe. [6] [3]